[Public Papers of the Presidents of the United States: George W. Bush (2004, Book I)]
[April 27, 2004]
[Pages 680-686]
[From the U.S. Government Publishing Office www.gpo.gov]



Remarks in a Discussion on the Benefits of Health Care Information 
Technology in Baltimore, Maryland
April 27, 2004

    The President. Thanks a lot. Thanks for coming. Please be seated. 
Thanks for the hospitality. I'm really pleased to be here in the great 
city of Baltimore. Governor, I'm 
proud you're here. Thanks for greeting us at the airport--I mean, at the 
heliport. Thanks for bringing the first lady. 
Thanks for bringing the Lieutenant Governor as well. I'm proud you all are here.
    I'm also proud to be with--in the presence of a man I still call 
Governor, Governor Schaefer. I'm proud 
you're here, Governor. He said he didn't care a whit about seeing me. He 
just wanted to make sure I gave his best to Mother. [Laughter] Still a 
plain-spoken fellow, aren't you?
    But Governor, thanks, you're doing a great job for the State of 
Maryland, and congratulations on the newest Ehrlich.
    Dutch Ruppersberger is with us 
today. Congressman, where are you? Oh, thanks for coming. Listen, I'm--
here's the thing about the Congressman: He cares deeply about the people 
who wear the Nation's uniform. He's very much involved with programs to 
kind of lighten the load for our troops who are sacrificing and are 
working for a free world. Dutch, I'm proud of the job you've done. I 
know you've recently received the USO Merit Award. Well deserved, and 
congratulations. Thank you for doing that.
    I want to thank George Owings and Larry 
Kimble, who are veterans affairs folks 
here for the State of Maryland. One is incoming. One is outgoing. Both 
care deeply about the veterans of this State. I appreciate so very much 
Nelson Sabatini, who is department of 
health and human services

[[Page 681]]

here in Maryland, for caring about the health delivery systems of your 
State.
    We're going to talk about some interesting opportunities today for 
our health care system to be modern, to deliver--help it deliver quality 
service at lower cost. This is going to be--I think you'll find it an 
interesting dialog. I'm certainly looking forward to it.
    Before we begin, though, I want to thank the people who work here at 
this hospital, work for the VA. I appreciate your service to our 
country. I appreciate your care for those who have worn the Nation's 
uniform. I see we've got folks here who have worn and are wearing the 
Nation's uniform. For those who have worn the Nation's uniform, thank 
you for setting such a good example for the brave men and women. For 
those who are wearing the Nation's uniform, I appreciate so very much 
your service.
    We're changing the world. We have an obligation and a duty to 
protect our country. And in so doing, we're changing the world for the 
better. We understand that freedom is the deepest need of every human 
heart and that free societies are peaceful societies. And a peaceful 
society in the heart of a region that has fostered terror and hatred is 
in our short-term and long-term interest. And for those who wear the 
uniform, thanks for what you're doing. You have stepped up at this 
historic time. And the country is more secure for it, and the world will 
be more peaceful for your service.
    Yesterday I talked about ways for us to make sure America stays on 
the--stays a leader in the world, particularly when it comes to 
technology and innovation. That's what we want. We want to lead. We're 
not interested in following. America is a nation where the 
entrepreneurial spirit is strong, where the focus of the Government, in 
my judgment, is right. We're willing to spend research money. I see 
Elias Zerhouni is with us, who's head of 
the NIH. Elias, thanks for coming. I'm confident that when you spend 
research money at the NIH, we're laying the groundwork for what will be 
a better tomorrow.
    Yesterday I talked about energy. One way for us to stay on the 
leading edge of an innovative society is to introduce ideas like a 
hydrogen-powered automobile, put money behind it and research behind it 
so someday, Governor, we're able to 
drive around with water as the byproduct, as opposed to that which is 
currently coming out of the tailpipes in America. It'll make us less 
dependent on foreign sources of energy when this technology comes to be, 
which is vital to make sure America is on the leading edge of technology 
and innovation. It'll help improve the environment.
    I talked about the need for us to spread broadband technology 
throughout our entire society if we want to stay competitive and 
innovative, that we've got to have broadband in every household in 
America by the year 2007. And there's ways to do that with the 
Government having to provide all the capital. We ought not to tax access 
to broadband. If you want something to flourish, don't tax it.
    As well we've got to make sure that regulatory policy in Washington 
is conducive for the spread of broadband. For example, one of the things 
that's probably going to need to be done is they're going to need to 
build towers on Federal lands in order for over-the-air Internet 
services to work out into the remote regions of our country. They don't 
need a bunch of paperwork and hassle in order to build the tower on 
Federal lands. There's a lot of things we can do to reduce the 
bureaucratic hurdles necessary to make sure that broadband is plentiful, 
and not only plentiful but there's competition so that you get better 
quality and better price.
    But today we're going to talk about a third avenue that's--to make 
sure America is innovative and is a leader in the world, and that is how 
to make sure our health care system works better. And there are some 
fantastic ideas as to how to do that.

[[Page 682]]

    The way I like to kind of try to describe health care is, on the 
research side, we're the best. We're coming up with more innovative ways 
to save lives and to treat patients. Except when you think about the 
provider's side, we're kind of still in the buggy era. I told a story 
yesterday of a guy in Kalamazoo, Michigan. His 
young daughter has a case of leukemia, and 
he had to--she had to see a lot of specialists. But he had to carry her 
files around every time she saw a specialist in order to expedite care, 
to make sure she was getting the best care.
    And the health care industry is missing an opportunity if patients, 
in order to make sure they get quality care, have to carry files from 
one specialist to the next. It's like IT, information technology, hasn't 
shown up in health care yet. But it has in one place, in one department 
that you're about to hear from, and that's the Veterans Department.
    So here's what we're here to talk about. We're here to talk about 
how to make sure the Government helps the health care industry become 
modern in order to enhance the quality of service, in order to reduce 
the cost of medicine, in order to make sure the patient, the customer is 
the center of the health care decisionmaking process.
    And we've made great progress. There's a role for the Federal 
Government. One thing is, the Federal Government has got to make sure 
the privacy rules are strong. You're going to hear us talk about 
electronic medical records, and that's exciting. But it's not so 
exciting if you're a patient who thinks somebody could snoop on your 
records, to put it bluntly. I'm not interested in having my--well, it's 
too late for me. [Laughter] My medical records are pretty well known.
    But for those people--there's a lot of people in America who say, 
``Good. I want there to be good information technology in the health 
care field. I just don't want somebody looking at my records unless I 
give them permission to do so.'' And I fully understand that. No, your 
records are private if that's the way you want them to be, but there's 
the ways to address this, the privacy issue. And there's the ways to 
make sure that the Federal Government's role is helpful in expanding 
information technology, and that's what we're going to talk about.
    Tommy Thompson is the head of the--the 
Secretary of Health and Human Services--is a strong advocate about the 
spread of IT throughout the health care industry. I think he's got--I 
know he's got the proper perspective of the role of the Federal 
Government in encouraging not only the Federal agencies but the private 
sector to adopt these strategies in a way that is positive for the 
American consumer and cost-beneficial for society.
    You'll hear him talk about standards. 
I told him when he starts talking about standards, ``Make sure it's the 
kind of language we all understand.'' See, that's part of the problem. 
The medical terminology is really different from English, and it's 
different from one office to the next. And so when Tommy is talking 
about standards, I think he'll help you understand how we can help with 
standards.
    At any rate, we're doing some smart things at the Federal 
Government, and the Federal Government can lead because we're spending a 
lot of money in health care. We're a large consumer on behalf of the 
American people. Think about it: Medicare, Medicaid, veterans' benefits, 
Federal employee health insurance plans. I mean, there's a lot of money 
going through the Federal Government, and therefore it provides a good 
opportunity for the Federal Government to be on the leading edge of 
proper reform and change.
    Tommy, thanks for your service. Let 
her go.

[At this point, Secretary of Health and Human Services Tommy G. Thompson 
made brief remarks.]

[[Page 683]]

    The President. Thanks, T, good job. 
It's estimated that they spend $8,000 per worker on information 
technology in most industries in America, and $1,000 per worker in the 
health care industry. And there's a lot of talk about productivity gains 
in our society, and that's because companies and industries have 
properly used information technology. If properly used, it is an 
industry-changer for the good. It enables there to be a better cost 
structure and better quality care delivered, in this case in the health 
field.
    And yet the health care industry hasn't touched it, except for 
certain areas. And one area that has is the Veterans Administration. 
You're about to hear an example from our Secretary and the administrator of this hospital and the assets here in Baltimore about forward thinking by 
people who care about the patients they serve. I know the veterans who 
are here are going to be proud to hear that the Veterans Administration 
is on the leading edge of change. That's what we expect. The taxpayers' 
money is being well spent.
    And one of the reasons why the Veterans Administration is doing so 
well in changing, kind of, behavior, as well as making sure the backlog 
for veterans cases has been reduced, is because of our Secretary, a 
Vietnam vet, a really decent guy, and who is doing a fabulous job, Tony 
Principi.

[Secretary of Veterans Affairs Anthony J. Principi made brief remarks.]

    The President. Thanks. I'm real proud of the job that you're doing 
here. Our job is to set the strategy. Smith's job here is to make sure they put it in place. [Laughter] 
Dennis Smith, as I've told you, runs the show here. Tell us how this 
happened. I mean, first of all, how long have you been working for the 
Veterans Administration?
    Dennis Smith. Thirty-one years.
    The President. Thirty-one years?
    Mr. Smith. Yes, sir.
    The President. You don't look that old. [Laughter]
    Mr. Smith. Thank you.
    The President. Maybe because you don't spend a lot of time in 
Washington. [Laughter] Explain your job, explain what this means--if you 
can possibly share some stories with us. You're doing a great job, by 
the way.

[Mr. Smith, director, VA Maryland Health Care System, made brief 
remarks.]

    The President. I presume it's cost effective?
    Mr. Smith. It is.
    The President. I mean, think about a system where you had to take 
each individual x-ray and put it in a shelf and get somebody to take it 
out of the shelf and put it back in the shelf and probably had to 
duplicate it just in case somebody wouldn't lose it. So when you hear 
him talk about cost-effectiveness and productivity increases, this is 
what we're talking about. This system, when it gets advanced beyond the 
VA, will save American consumers a lot of money. If we're wise about how 
we use technology, we can save money.
    Anyway, sorry to interrupt. [Laughter]
    Mr. Smith. That's quite all right. 
[Laughter]
    The President. The man knows the chain 
of command. [Laughter]

[Mr. Smith made further remarks.]

    The President. Let me ask you, was it hard to get all the records 
computerized in the first place? I mean, somebody is listening out there 
who is running a hospital in Dallas, Texas. Are they going to say, 
``Gosh, this is such an overpowering startup that it makes no sense to 
do so?''
    Mr. Smith. Well, with the VA, we kind of 
started years ago with this. We started with physician-order entry. And 
we had packages. We had a lab package. So we brought lab on board, where 
the physicians would order their lab work, and that would be automated. 
And then we went to various

[[Page 684]]

other systems. So it was gradual that we did it. It is a daunting task 
for the hospital sector to bring in a computerized medical record all at 
one time. So no doubt, but it has to be done, Mr. President. We have to 
do it.
    The President. The goal I set is, most people ought to be covered 
within a 10-year period. It's not like in 10 days or 10 months. This is 
something that is going to take time to get there.
    Tell me about the pharmaceuticals, the distribution of drugs, the 
barcoding and how that affects----

[Mr. Smith made further remarks.]

    The President. How do you deal with the privacy issue? In other 
words, there's some suspicious character around that doesn't----
    Mr. Smith. Well, the nurses all have 
codes to get into the system, so you have to have a security code to get 
in. So before--you can't just go up to a computer. We have these on 
medication cards, laptops, so they have to type in a code to get into 
it. So we know--the system knows that, if I was a nurse, Dennis Smith is 
in the system. And I'm visiting Mr. Principi in his room and click on, 
it will know that I'm administering the drug and who the patient is. It 
brings all that up. It's a very secure system. We've built security into 
this.
    The President. Good. You're doing a great job.
    Mr. Smith. Thank you, Mr. President.
    The President. Thanks a lot. One of the things that's interesting, 
one of the challenges we face in our society--Governor Ehrlich understands this--is we've got to make sure we 
train people in the health care field who understand what they're doing 
when it comes to computers and information technology. There's a lot of 
jobs available in the health care field, and the community college 
system turns out to be a great laboratory for enhancing people's skills. 
And I appreciate your support of the community colleges here in 
Maryland, giving people a chance to learn a new skill to meet the 
challenges of the--when I say, ``challenges of the 21st century,'' 
here's one: Figure out how to use IT in a constructive way to save costs 
and improve quality care and to save lives. I suspect 20 years ago 
people who were in the health care field simply could not envision the 
use of computers and broadband and the Internet to make the field 
modern. And our education system has got to reflect that, Governor. I 
appreciate your understanding.
    So far you've only heard from the public sector. It probably makes 
sense to hear from the private sector today as well, since the delivery 
of health care in the private sector is equally if not greater part of 
people's--the quality of medicine here in the country.
    Johns Hopkins is one of the really great hospital university systems 
in America. It's world renowned, and it's quality care. With us today is 
Marlene Miller--Dr. Marlene Miller, I 
might add. She is in charge of the office of quality and safety 
initiatives at Hopkins. Tell us what that means, and just give us a 
sense of the challenges you face and the challenges we face in 
encouraging the spread of information technology to the private sector. 
Is Hopkins involved with any of this, or anything else you want to say?

[Marlene Miller, director, Quality and Safety Initiatives, Johns Hopkins 
Children's Center, made brief remarks.]

    The President. Yes, see, the VA has got an advantage because all the 
administrators work for the same outfit, the same organization. Hopkins 
stands alone. I suspect Hopkins doesn't do a very good job of conversing 
with M.D. Anderson in Houston. Two different languages--no, anyway. 
[Laughter]
    And so the real challenge in the private sector is to take what the 
Johns Hopkins people have done intrahospital and have it be able to 
converse with both large and

[[Page 685]]

rural hospitals all across America. And that's where the Federal 
Government can help, like the development of standards. I guess you 
support the development of standards when it comes to talking over the 
Internet?
    Dr. Miller. Absolutely.
    The President. What other challenges do you see?

[Dr. Miller made further remarks.]

    The President. Let me ask you something. Are you saying that these 
systems are able to build in a kind of a safety valve--in other words, 
automatically kick out a prescription if it doesn't meet the logic of 
the computer program?
    Dr. Miller. One aspect of an ideal 
system, in my mind, is if I prescribe you 50 milligrams of something, 
but the 10 prior visits I prescribed you 5, I should get a warning flag, 
and say, ``Look, do you really mean this?''
    The President. But what you said about the weight, something----
    Dr. Miller. Well, it's the same issue 
in children.
    The President. If you've got small children, it is illogical to 
prescribe this much dosage.
    Dr. Miller. Yes, the prescription I 
talked to you about was an adult-sized dose. No one, had they looked in 
any textbook, would have ever given that child that dose.
    The President. Pretty good. That's why you've got to get the 
standards right, Tommy.

[Secretary Thompson and Secretary Principi made brief remarks.]

    The President. This is a big challenge for us here in the country. 
Think of what we're talking about. We're just talking about how 
hospitals talk to each other. Then we've got to get it so the docs are 
able to talk to each other, and they've got to buy into this.
    And so the reason why we've started this process now is we want to 
encourage insurance companies and State governments, doctors 
organizations, AMA, and others to understand the great benefit for the 
American people by implementing information technology in the health 
care field.
    By introducing information technology, health care will be better, 
the cost will go down, the quality will go up, and there's no telling 
whether other benefits will inure to our society. In other words, when 
we get this done--and we will, because America is a land of doers and 
entrepreneurs; our job is to set the goal and then to encourage and 
incent people to achieve the goal--but when we get this implemented, 
America will remain on the leading edge of technological change. This is 
the kind of innovation that's practical and makes sense, that will keep 
us to be the leader in the world.
    And when we're the leader of the world, it means our people have a 
chance to make a better living. See, when you're the leader, 
particularly when it comes to innovation and technology, your society 
improves a lot. The quality of life goes up. People's pay goes up. 
People in America are more likely to realize the American Dream. It's 
essential that we be in a society of innovators and change, and this is 
an area where there is a huge opportunity.
    And I look forward to working with people to achieve this objective. 
I want to thank those up here who are doing a good job. Tony, you all have made us proud. I'm giving Tony the 
credit, but you deserve it. [Laughter]
    Marlene, thank you for your vision. We 
look forward to working with Johns Hopkins as to how--to better learn 
how to encourage implementation of this opportunity. And when we get it 
done--we will--we will--this is America, after all. [Laughter] And when 
we get it done, we'll all be able to say, ``We've done our duty, job 
well done. Now we go on to the next issue after this.'' But let's get 
this one right.
    Thank you all for coming. We've enjoyed it. I hope you found it as 
interesting as

[[Page 686]]

I have to listen to the great opportunities in front of us, some of the 
challenges that have been overcome, and recognizing that we've got other 
challenges to overcome. But our spirits are high. Our spirits are high 
because this country can overcome any challenge in our way.
    God bless. Thank the healers who are here. God bless the veterans as 
well.

Note: The President spoke at 1:50 p.m. at the Department of Veterans 
Affairs Medical Center. In his remarks, he referred to Gov. Robert L. 
Ehrlich of Maryland, his wife, Kendel, and their newborn son, Joshua; 
former Gov. William Donald Schaefer of Maryland; George W. Owings, 
secretary-nominee, and Lawrence J. Kimble, acting secretary, Maryland 
Department of Veterans Affairs; and Nelson J. Sabatini, secretary, 
Maryland Department of Health and Mental Hygiene. The related Executive 
order of April 27 on incentives for the use of health information 
technology and establishing the position of the National Health 
Information Technology Coordinator is listed in Appendix D at the end of 
this volume.